The Nutrients Journal recently published an article that analyzed the effects of pizza and its ingredients on RA disease activity in patients.
Is there a correlation between pizza consumption and an increase in disease activity in Rheumatoid Arthritis? Source: VasiliyBudarin/Shutterstock.com.
What is the background?
The majority of rheumatoid arthritis patients cannot easily achieve low disease-activity states or sustained remission. As a result, active and in-remitting cases of this chronic inflammatory disease with multiple joints and autoimmune pathogenesis are increasing in number around the world, including Italy.
The management of RA is a significant public health concern. Patients and healthcare professionals are constantly seeking new ways to reduce the burden of the disease. Initially, researchers focused on administering DMARDs to alleviate long-term complications associated with rheumatoid arthritis, but now they have turned their attention to exploring the role of diet in reducing dietary restrictions for autoimmune diseases.
The majority of observational studies focused on the impact of short-term dietary interventions on RA activity. It is necessary to modify the design of studies investigating RFPA in rats because the small-scale actual benefit of a typical diet could be more important than the short term benefits of interventional calorie intake programs.
Studies on pizza’s impact on health are limited, except for studies on cancer and cardiovascular diseases. Thus, there is a lack of research on whether eating pizza can affect inflammatory diseases like RA.
What is the study’s subject matter?
Consequently, the current investigation centered on pizza as the main topic of their RA activity studies, which is a food item that is widely available worldwide at varying prices and in good taste.
Pizza is not considered unhealthy or junk food in Italy, where 44% of the population prepares and consume it at home, and 58% use pizzerias or cook it themselves, which is significantly higher than the global average.
Pizza is a one-of-a-kind dish made with fresh mozzarella cheese and “pomodorini” (cherry tomatoes) on pliable dough made from lean type wheat flour, which is filled with water, salt, and yeast in accordance with Italian culinary norms.
Pizza consumption in the United States of America (USA) reaches 13 kilos per capita per year, with its 75,000 pizzerias selling both frozen and pizza. These differences highlight the importance of investigating how pizza consumption affects RA patients in Italy.
All the patients who were recruited were aged between 18 and 65 years old, had been diagnosed with RA for at least three months, and met the corresponding RF classification standards set by either the American College of Rheumatology (ACR) in 1987 or the European League Against Rhematism in 2010, respectively.
The team collected sociodemographic and anthropometric characteristics, cigarette smoking and alcohol consumption statuses, and medical history of all the participants. They then used two composite measures, the Simplified Disease Activity Index (SDAI) and the Disease Actuarial Score (DAS28-CRP), to assess their RA activity.
The team asked the participants to complete an 110-item food frequency questionnaire (FFQ) that categorized their intake of food, drinks, and foodstuffs into categories such as “never” and “4 to 5 times per day”, in order to gather information on these items.
The current study analyses only included 365 subjects out of the 366 participants in the study after the researchers removed the unreliable participants who filled out the FFQ.
The researchers analyzed the impact of both free and ad libitum consumption of pizza, refined flour, olive oil, and mozzarella cheese. The refined-grains food group included bread and bakery products, pasta, rice, corn flakes/wheat cereals, among other things.
The team employed robust multiple linear regression models to measure RA activity as the dependent variable and each pizza-related food item as independent variables. They also conducted stratified analyses based on ras, severity, or duration of remissions.
The outcomes and conclusion
Individuals who ate half a pizza more than once per week were found to have positive effects on disease activity in higher consumption groups, with substantial safeguards of 0% in the overall study compared to those who consumed pizza fewer than two times per month.
The positive outcome in the more severe stratum was marked by reductions in risk values to 80%, as determined by logistic regression and linear models, with beta coefficients of 0.70 for the DAS28-CRP and a correspondingly smaller value of 0.066% for SDAI in higher-risk RA strata.
In the more severe tier, mozzarella cheese and olive oil also had positive effects with observed statistical significances of 0.37 and -2.09 for the DAS28-CRP and SDAI in two of the four models fitted.
The birthplace of pizza is Italy, where the freshest ingredients are available. This ensures that people who consume pizza in Italy receive the optimal anti-inflammatory and antioxidant benefits.
The authors observed that the consumption of pizza, mozzarella cheese, and olive oil was associated with an improvement in the composite, internationally recognized measures of RA disease activity.
Nevertheless, future cohort studies must verify the positive effects of pizza and related foods on RA disease activity, taking into account various confounders.